Diagnosis and treatment of breast cancer

Breast cancer is characterized by the growth of malignant tumors in the glandular tissue of the breast. Today, more women are surviving breast cancer than ever. More than two million women are victims of breast cancer. With early detection and timely and appropriate treatment, the prognosis for women with breast cancer can be positive.

No one knows why some women get breast cancer and others do not. Although the disease can affect younger women , 75 % of all breast cancers occur in women 50 years or older. Some of the above risk factors include family or genetics, estrogen exposure , demographic factors (age, race, ethnicity and socioeconomic status) , nutrition and lifestyle and smoking.

Symptoms of breast cancer are barely noticeable when it starts to develop, but as the cancer grows, it can cause changes that women should watch. The most common symptom is an abnormal swelling or mass in the breast, but the pieces can also appear next to the breast or underarm . Other symptoms may include unexplained chest pain , abnormal nipple discharge, changes in the texture of the breast skin or changes in or around the chest .

Screening for breast cancer

To screen or not to screen – that is the dilemma . The problem is not purely medical , but also a matter of economics . The diagnosis of cancer , whether initial or subsequent offense , is the period of acute stress of a cancer patient . This crisis is defined by sadness (depression ) , fear (anxiety ) , confusion and occasional anger.

The purpose of screening women for breast cancer is to detect cancer in its early stages , when surgery and medical treatment may be more effective in reducing mortality. Detection is only beneficial when it results in earlier diagnosis to a reduction in the risk of mortality and morbidity , and when the screening test is low. There are three methods of detection of breast cancer that are practiced today: X -ray mammography , clinical breast examination and self-examination.

Of the three detection methods, the most reliable is by far mammography. However, for women with dense breast tissue , both ultrasonic and mammograms may lack tumor , which , however , can be detected by magnetic resonance imaging ( MRI) . MRI is more accurate in detecting cancer in women carrying the BRCA1 and BRCA2 breast cancer gene. However, the primary means of diagnosis – and many people believe that the end – is a biopsy – a minor surgical procedure in which part of the song or the mass is removed and examined under a microscope for cancer cells. A doctor can practice fine needle aspiration , a needle or a biopsy or surgical biopsy.

mammography

A mammogram is a special x-ray of the breast that can often detect cancers that are too small for a woman or her doctor to feel. The purpose of screening for detection of breast cancer at a very early stage, when chances for recovery. The amount needed to produce a clear mammogram (image) radiation varies with breast size and density. To avoid excessive exposure , it is highly desirable to use the lowest possible dose of radiation required .

Mammography can not distinguish between a benign or malignant tumor and is not 100 % accurate. However, mammography detects more than 90 % of all breast cancers negative mammogram does not necessarily indicate . Mammography and clinical examination are complementary and there is a strong suspicion of a palpable lesion , the only way to make a positive diagnosis , is to have a biopsy.

The results of several large studies have convincingly demonstrated that the detection of breast cancer with mammography reduces mortality by 30% in women over 50 years. The American Cancer Society says women between 40 and 49 years should receive screening mammograms every one to two years. Annual mammography for women 50 and older is recommended.

However, the risks of screening intervention should be evaluated more closely advantages. The risks associated with mammography screening for breast cancer include radiation exposure , false positives and overdiagnosis . The risk of breast cancer induced by radiation from mammography screening is estimated at a minimum. The increased risk of breast cancer caused by radiation increases at a younger age of women in the exhibition and increase the cumulative dose of radiation. However, the benefits of mammography is still clearly outweigh the risks of radiation-induced breast cancer.

Clinical breast exam ( CBE)

On clinical examination , the doctor will evaluate the breasts and underarms for lumps or other changes that could be a sign of breast cancer. The EPC involves bilateral and palpation of the breast and axillary examination and supraclavicular areas . The examination should be conducted in both standing and supine. One of the best predictors of the accuracy of the test is the amount of time spent by the examiner.

CBE effectiveness only in the screening for breast cancer is unclear. The results of several large studies have convincingly demonstrated the effectiveness of EPC when combined with mammography screening for breast cancer in women over 50 years. The American Cancer Society recommends that women should have a CBE every three years from 20 years to 39 years. Annual CBE should be performed in women aged 40 years and over.

Self-examination (BSE )

A systematic review of a woman in which she uses her fingers to feel the changes in the shape of the breasts and nipple discharge fluid to detect any abnormalities . It is ideal to make every month. Estimates vary, but 80 to 95% were first discovered as a lump by the patient. Intuitively , it follows that regular self-examination as a screening modality perhaps complementary to mammography can help detect cancer at an early stage, when the prognosis is more favorable.

Nearly four in five breast tumors detected thus become a cyst or other lesion (noncancerous) benign. If you find a lump , however , it is essential to determine as soon as possible if it is cancerous or not. At present there are several epidemiological studies indicate that survival is higher in women who practice self-examination and that cancers detected by self tend to be smaller .

treatment

Once discovered breast cancer , which is staged . With staging, the doctor can tell if the cancer has spread and , if so , to what parts of the body. Other tests may be performed to determine the stage . Knowing the stage of the disease helps the doctor plan treatment.

The choice of treatment for breast cancer depends on the woman’s age and general health , and the type, stage and location of the tumor and whether the cancer has remained within you is extended to other parts of body. There are a number of treatments, but women more often choose – alone or in combination – are surgery , radiotherapy , chemotherapy and hormone therapy .

The standard treatments for cancer are generally designed to be the cancer with surgery , prevent cancer cells of the hormones they need to survive and grow through hormone therapy , the use of high-energy beams to kill cancer cells and shrink tumors by radiation and anticancer drugs to kill cancer cells by chemotherapy.

However, maintaining the current view that cancer is a systemic disease that affects the complex spectrum of host relationships – tumor , the cancer cells spread through the blood , and therefore it is unlikely that variations in the Local or regional therapy affect survival of a patient. Instead , the cancer must be attacked systemically, by the use of radiotherapy , chemotherapy, hormone therapy and immunotherapy.

For women with breast cancer at an early stage, a common treatment available is a lumpectomy and radiation therapy. Lumpectomy is a surgical procedure that preserves the breast of a woman . In ablation , the surgeon removes the tumor and a small amount of surrounding tissue. The survival rate for a woman who has more radiation treatment is similar to that of a woman who chooses a radical mastectomy, which is the complete removal of the breast.

If the breast cancer has spread locally – only to other parts of the breast – Treatment may include a combination of chemotherapy and surgery. Doctors initially reduce the tumor to chemotherapy, then remove with surgery. The reduction of the tumor before surgery may allow a woman to avoid a mastectomy and keep within it.

If the cancer has spread to other parts of the body such as the lungs or bone therapy chemotherapy and / or hormone can be used to remove the cells and control of the disease of cancer. Radiation therapy may also be useful to control tumors in other parts of the body.

Because 30 % of recurrence of breast cancer, the National Cancer Institute urges all women with breast cancer with chemotherapy or hormone therapy after surgery , even if there is evidence that cancer s ‘ spread. As an adjuvant systemic treatment , as it is called , can prevent or delay of approximately one third of recurrences.

Prevention of breast cancer

Breast cancer can not be completely avoided , but the risk of developing advanced disease can be greatly reduced by early detection.

There are several medications available to treat or prevent breast cancer . Chemopreventive agents such as tamoxifen and raloxifene act to prevent the development of breast cancer by disrupting the process of initiation and tumor promotion . The anti-estrogenic effect of these agents also seems to lead to inhibition of malignant cell growth . Chemoprevention is the most promising intervention for the implementation of primary prevention at this time.

tamoxifen

Tamoxifen is a nonsteroidal antiestrogen with partial estrogenic agonist effect . It is FDA approved , and is now used for patients with cancer and also estrogenreceptive for people at high risk who are still menstruating and produce considerable estrogen .

Administered orally , can increase the risk of endometrial cancer stage I and can also worsen vaginal dryness and hot flashes. Tamoxifen may be less effective as a preventive agent in women with a strong familial breast cancer .

raloxifene

Raloxifene hydrochloride is a selective estrogen receptor modulator (SERM ), which blocks the action of estrogen in the breast and endometrial tissue . The incidence of positive invasive breast cancer estrogen receptor was reduced by 76 % among women treated with either dose of raloxifene at 40 months follow-up period . Raloxifene side effects include increased risk of thromboembolism , but no increased risk of endometrial cancer .

Furthermore, recent studies have linked low incidence of breast cancer with various environmental factors , especially food . Food touted to be the cancer preventive soy (found in foods such as tofu, tempeh , soy milk and vegetarian meat substitutes ), but there is no clear evidence for this assumption. Eat more fruits and vegetables, eat less red meat (perhaps substituting soy protein ) and prevent cholesterol ( not olive oil ) may also help prevent breast cancer .

A chemical ( indole – 3-carbinol or I-3- C ) found in broccoli , cabbage and other cruciferous vegetables are now available as a dietary supplement may help prevent breast cancer associated with estrogen. Another possible preventive measure is regular use of standard doses of anti -inflammatory drugs such as ibuprofen and aspirin two or more times a week .